Rare Cancer Treatment Comes to New Jersey

Proton therapy, which kills malignant cells without damaging healthy tissue, is now available at two in-state facilities.

ProCure treatment room.

Cancer patients in New Jersey will no longer have to travel out of state to receive a cutting-edge treatment called proton therapy, which delivers high doses of radiation noninvasively with minimal side effects.

In the past, residents of New Jersey and New York seeking this advanced treatment most likely traveled to the nearest facility in Philadelphia at the University of Pennsylvania’s Roberts Proton Therapy Center.

Now, there are two proton beam facilities in state.

“A large part for me was making it available to the community and certainly the community I’m a part of,” said Dr. Henry Tsai, a New Jersey native and principal investigator for clinical trials at ProCure Proton Therapy Center.

Led by a team of 10 doctors, ProCure opened a 60,000-square-foot therapy center in Somerset in March. The for-profit chain operates two other proton centers in the U.S.

Proton beam therapy is used most often to treat prostate cancer. According to Stephen Schimpff, former CEO of the University of Maryland Medical Center, that's because Medicare pays for this treatment.

“That’s where it’s being used a lot and why centers are opening up,” he said.

Because protons directly target cancer cells without damaging healthy tissue -- and growing tissue in children -- this form of therapy is also beneficial for treating many pediatric cancers, said Schimpff. It can also treat tumors in the brain, lungs, head, and neck -- which are often hard to reach.

In 2009, the Centers for Medicare and Medicaid Services gave state Medicare administrative contractors the power to decide if certain cancers could be treated with proton beam therapy. According to a May Agency for Healthcare Research and Quality (AHRQ) report, which examined growth in proton therapy for Medicare beneficiaries between 2006 and 2009, prostate cancer accounted for 73 percent of the cases reimbursed by Medicare in 2009. The average reimbursement was approximately $25,000.

Some private insurers are also willing to cover the therapy.

Proton therapy has been around for decades but is only used in about 1 percent of all radiation therapy cases, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

“We expect it to rise to five percent in the next couple of years. At the moment, there are currently 10 operating centers around the country and another 10 under construction or in the pipeline,” he said.

One of the major reasons why proton therapy has been slow to catch on is the cost of building and equipping the requisite facilities -- an investment that can exceed $100 million. Proton therapy requires large magnets and gantries, but at the center of it all sits a 200-ton cyclotron that accelerates protons to two-thirds the speed of light.

It took ProCure New Jersey 23 months and an initial investment of $160 million to complete the Somerset facility. Tsai said the building holds four treatment rooms, which they have been opening in a phased progression.

New Jersey welcomed its second proton therapy center in July when Mevion Medical Systems, a company based in Littleton, Mass., delivered its smaller-footprint proton therapy unit to the Robert Wood Johnson University Hospital in New Brunswick. This is only the second unit the company has installed in the U.S.

"It’s the same proton that we are generating clinically to treat the patient, the difference is in the scale of the device itself," said Lionel Bouchet, senior director of product management at Mevion.

He said a unit like this, which costs roughly $30 million, is a good fit for a cancer center that wants to add proton therapy to its treatment options.

According to Tsai, there have been several clinical trial results showing the benefits of proton therapy for pediatric and prostate cancers, but further research on these cancers and others remains an important goal for the entire proton therapy community.

“Now that we have upward of nine to 10 centers [nationally] which is not that many in the grand scheme of things -- we can start collaborating and enrolling patients in more clinical trials,” he said

Studies comparing clinical superiority of proton therapy to conventional photon (X-ray) radiation therapy, which costs about half as much, should be a top priority, particularly for prostate cancer, Schimpff said.

According to a March paper published in the journal Medical Physicists, no randomized controlled trials directly comparing photons to protons have yet been completed.

Loren Bonner is a healthcare reporter based in New York City. She currently writes for a medical trade publication focused on technology and imaging.